title: Evaluating outcomes of enterocystoplasty in patients with spina bifida: a review of the literature.
abstract: OBJECTIVE
  The urological complications of spina bifida impose a significant burden of disability and disease. Therapy is focused on the bladder to achieve the primary goals of maintaining normal renal function and attaining urinary continence. When medical management fails, surgical intervention, including enterocystoplasty, is frequently performed. However, practice patterns for enterocystoplasty show significant variation. Given this context, we examined outcome measures for enterocystoplasty in patients with spina bifida.
  
  
  METHODS
  A MEDLINE search was performed for articles on enterocystoplasty in patients with spina bifida. A total of 226 articles were identified and manually reviewed for relevant studies. Additional articles were selected based on a cited reference search.
  
  
  RESULTS
  Almost all studies are retrospective, single institution case series of a relatively small number of patients. Few uniform or validated outcome measures for enterocystoplasty exist but reported measures typically include urodynamic, continence and satisfaction parameters. Interinstitutional variability in urodynamic measurements and in definitions of continence makes a comparison of outcomes difficult. The complication rate following enterocystoplasty is significant, well described and primarily related to the use of gastrointestinal segments for urine storage.
  
  
  CONCLUSIONS
  Medical management is the mainstay of neurogenic bladder therapy in the spina bifida population. Enterocystoplasty remains an important option to prevent or reverse upper tract deterioration, and/or improve or cure socially unacceptable incontinence despite poorly defined outcome measures. The development of appropriate and validated outcomes measures may enable more uniform, effective and safe urological care of patients with spina bifida.
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.forename: John S
authors.initials: JS
authors.lastname: Wiener
mesh_terms: D006801:Humans; D007422:Intestines / Q000637:transplantation*; D016135:Spinal Dysraphism / Q000150:complications*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods